In their own words: participants' perceptions of the impact of adult day services

Experiences of Disabled Older Adults in Urban Area Adult Day Care Centers: A Multisite Case Study

This study described clients' experiences within adult day care (ADC) and its related impacts. A multisite case study was conducted with 26 older adults from six ADCs in Tokyo, with interviews and field observations conducted between November 2020 and July 2022. The transcribed interviews and field notes were analyzed qualitatively. Three categories pertaining to context ("guilt and resignation to the current living conditions," "desire for social connection despite frustrating limitations," and "supported life based on weekly ADC routine") and four categories about the experiences within ADC ("savoring disability- and age-friendly conversations," "feeling happy about something new and positive," "challenges for changes in self-image," and "discomfort with others and the waste of time") were extracted. Clients' increased vulnerability due to disabilities and COVID-19 affected their experiences. ADCs provide a safe place for interaction, and their use must be encouraged to develop a disability- and age-friendly society.

'I go home with a happy heart'. Enhancing community aged care services to sustain togetherness: Perspectives from Australian staff and clients

Social participation is critical to the health and well-being of older adults, however, participation often declines with age. Research has identified that personal and environmental factors such as high socioeconomic status and accessible transportation are associated with higher levels of social participation. However, the barriers and facilitators to social participation experienced by older adults receiving community aged care services remains largely unexplored. This qualitative study aimed to generate context-rich data and identify the barriers and facilitators to effective community care services that can support older adults' participation in the community and contribute to individual well-being. Semi-structured focus groups were conducted with 40 community aged care clients and 21 staff members between January to July 2018 and thematic analysis was undertaken. Environmental factors, such as availability and accessibility of transportation services emerged as the most important factors influencing participation. Older age, self-attitude towards one's own functional ability and limited social networks were important personal factors affecting participation. Proactive aged care services (e.g., engaged staff, tailored activities) were reported to assist with continual engagement in aged care services. In contrast, the type, location and accessibility of the activity, associated costs and limited options for accessible transportation were key barriers to older adults' social participation. Pathways contributing to positive engagement were complex and variable, but personal well-being and local community resources emerged as important factors encouraging higher social participation. These findings are discussed in the context of the ongoing pandemic and implications for future aged care services are provided.

Adult Day Service Use Among Minority Older Adults: Facilitators, Barriers, and Outcomes From an Updated Integrative Literature Review Between 2010 to 2021

Adult day services (ADS) are one of the more popular long-term care options for racial and ethnic minority older Americans. Focusing on minority older adults, this study aims to (a) identify both the individual and structural/organizational levels factors associated with ADS use and to (b) examine ADS' effect on health and well-being. Using the integrative review approach of Whittemore and Knafl, we found 14 studies published between 2010 to 2021. Findings concluded that individual-level needs and enabling factors were associated with ADS use and outcomes among minority older adults centered mostly on quality of life. Organizational/structural characteristics of ADS were never empirically examined in relation to service use or health outcomes. Future research should move beyond the individual level to identify and address the impact of the institutional structure, culture and practice on access, quality, and use.

Experiences of Disabled Older Adults in Tokyo's Adult Day Care Centers during COVID-19-A Case Study

The COVID-19 pandemic resulted in social isolation among elderly people with disabilities. Adult daycare (ADC) is an important community care option for socialization among people with disabilities. However, their experiences with ADC remain underexplored. Thus, this study investigated the experiences of community-dwelling disabled elderly with ADC from the perspective of socialization. Four older women from Tokyo with disabilities, availing of one ADC service, were interviewed across two sessions between November 2020 and January 2021. The transcribed interviews and field notes were analyzed qualitatively. This yielded eight categories: two pertaining to context ("restricted social interaction outside of ADC", "feeling simultaneously grateful and ashamed of oneself as a recipient of care services"), and six pertaining to experience with ADC ("take a catastrophic defensive posture in situations where one's perception of value is shaken", "express oneself positively to justify one's daily life", "have trouble knowing what to do", "put oneself in a shaded exchange relationship", "examine the value of elderly people in need of care in society", and "savor regular contact with others"). Ensuring the use of ADC as a safe place for interaction while considering pandemic-related needs is important to develop policy and practical responses to restricted socialization during COVID-19.

Adult Day Program Directors' Experiences Managing the COVID-19 Pandemic

Adult day programs (ADPs) provide community-based supervised recreational services to older adults living with chronic conditions and their caregivers. Most ADPs continued operating during the pandemic, tasking directors with the responsibility of managing the complexities of the coronavirus disease (COVID-19) pandemic. This study explored how ADP directors managed and experienced the COVID-19 pandemic. Semi-structured interviews were conducted with 18 ADP directors from a large health care region in Ontario. Thematic analysis resulted in four themes that detailed how participants: 1) responded to the pandemic with adapted services; 2) navigated the pandemic responses within systems and organizations, and with each other, clients, and caregivers; 3) felt personally during the pandemic; and 4) gained new insights on their clients and the importance of ADPs in the health care system due to the pandemic. Findings highlight pre-existing and emerging gaps and opportunities within ADP service provision for clients and caregivers, as well as service providers and directors.

What is the impact of day care on older people with long-term conditions: A systematic review

There is a lack of robust evidence regarding outcomes for day care use among older people living with long-term conditions (LTCs). Day care is provided by independent, private and voluntary and charitable sectors. This systematic review aims to establish current evidence of outcomes for older people with LTCs attending day care services and outcomes on carers, across all service models. Narrative synthesis of quantitative and qualitative data was undertaken. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic literature search was carried out across eight electronic databases and reference lists of key journals between 2004 and October 2020 were searched. Searches returned 1,202 unique titles. Forty-five articles from 16 countries met the criteria on review of title, abstract and full article. There is limited evidence suggesting improved levels of perceived psychological health, quality of life, perceived general health, physical health and functioning for older people attending day care who have LTCs. The respite function of day care resulted in positive outcomes for carers. Studies evaluating outcomes for participants or carers were limited in quantity and quality. There is limited information regarding outcomes for day care attendance for older people with multiple LTCs from existing literature. Further research focusing on LTCs and day care attendance would benefit this field.

Service Use Objectives among Older Adult Day Care Clients with Disability in Japan

Quality assurance in long-term care settings requires outcome evaluation reflecting client-specific needs of service use. This study aimed to explore the clients’ needs of adult day care (ADC). Data of 360 clients from 11 ADC agencies in Japan were analyzed. Clients’ needs for ADC use were evaluated by their respective ADC staff using 17 items of four domains: “social participation,” “hygiene and health,” “exercise and eating habits,” and “family support.” The prevalence of four domain needs was calculated and the relationship between physical independency and the presence of needs in the four domains was examined by the chi-squared test. A total of 291 (80.8%) clients had one or more needs while 69 (19.2%) clients had none. The social participation need was most prevalent (270, 75.0%) and 249 clients (69.1%) had combination needs, including social participation, along with another domain. “Feeling like revisiting the ADC” was the most common need (60.6%); it was more frequently needed by those with a higher level of independence (p = 0.003). The study findings suggest that an outcome measure relevant to social participation can be considered as the most common benefits of ADC use. However, ADCs with clients who are more dependent should consider hygiene, nursing, and family support needs.

Outcomes for older people with long-term conditions attending day care services delivered by paid staff or volunteers: a comparative study

Background:

Day care services support older people living with long-term conditions (LTC’s).

Aims:

The aims of the study were to determine outcomes in terms of loneliness and health-related quality of life for older people with LTCs attending day care services in the United Kingdom.

Methods:

Newly referred older people with LTCs to day care services in North West of England and Wales were invited to participate. The EQ-5D-3L and De Jong Loneliness questionnaires were completed at recruitment, 6 and 12 weeks.

Results:

Ninty-four older people (64% female), age range 65–99 years; mean number of LTCs 4.3 (range: 2–9) were recruited. About 52% lived alone and 36% lived in one of the 20% most deprived local authorities in England and Wales. Outcomes over 12 weeks were comparable for paid, blended, and for volunteer-led services.

Conclusion:

Following the Covid-19 pandemic, it is increasingly urgent to support older people with LTCs who may have lost physical and cognitive function during lockdown and to support their recovery. Our study suggests that volunteers can provide services and complement the care provided by paid staff, freeing up resources and enabling increasing numbers of older people to be supported.

Using Standardized Tools to Characterize Adult Day Program Populations: Implications for Future Research and Clinical Practice

OBJECTIVES

To demonstrate the usefulness of primary data collection using clinician-rated and self-rated standardized measures to describe adult day program (ADP) populations and address programming issues such as identifying members at risk of dropping out.

SETTING AND PARTICIPANTS

One ADP in London, Ontario, and 2 ADPs in Toronto, Ontario, Canada. A total of 223 community-dwelling older adults were recruited across the 3 different programs.

METHODS

The interRAI Community Health or Home Care Assessment and self-rated psychosocial assessments were collected on program enrollment. Data analyses included descriptive statistics, comparison of the populations between ADPs, and multinomial regression models to assess reasons for program withdrawal.

RESULTS

Mean ages across the 3 programs ranged from 78.3 to 83.8 years and the proportion of women ranged from 49.3% to 56.6%. Compared with one of the ADPs, members from 2 other ADPs exhibited higher use of mobility aids (P < .001), higher levels of cognitive impairment (P < .05), increased risk for institutionalization (P < .001), lower levels of depression (P < .01), and greater need for supervision for basic and instrumental activities of daily living (P < .01). Members assessed to be at higher risk for institutionalization and have increased medical complexity showed possible association with program withdrawal at one ADP.

CONCLUSIONS AND IMPLICATIONS

The tools were useful in identifying differences in physical and psychosocial characteristics of members across the 3 ADPs. Information collected from interRAI and self-rated psychosocial assessments may be helpful in the development of individualized care plans, program services, and recommendations that target transitional care. By understanding member profiles and reasons for withdrawal, ADPs may be able to develop strategies to help members stay in the program and live in the community longer.

Measurement Development for Japanese Clients' Experiences during Adult Day Care Service Use (The J-AdaCa Tool)

Adult day care (ADC) is among the most common services in the Japanese long-term care context, but information on how such care is offered remains scarce. This study aimed to develop a measurement tool to assess the richness of clients’ experiences regarding their ADC service use. Through a collaboration with ADC administrators and staff, semi-structured interviews were conducted with three ADC clients (in one ADC agency), and a questionnaire survey (17 items about clients’ and their families’ experiences within ADC) was applied to 360 ADC clients (in 11 ADC agencies). Principle component analysis showed four factors regarding experience of ADC use: “Social participation”, “Hygiene and health”, “Exercise and eating habits”, and “Family support”. These positive experiences might be effectively provided if stakeholders refer to clients’ needs during ADC experiences, and their effective provision may relate to better care outcomes.

Application of randomization techniques for balancing site covariates in the adult day service plus pragmatic cluster-randomized trial

Cluster-randomized trials (CRTs) are increasingly common in pragmatic trials of interventions for older adults, where staff of existing clinics or service agencies deliver interventions. The Adult Day Service (ADS) Plus intervention is delivered by trained staff at adult day service facilities to assist older adults with cognitive impairments and their family caregivers. Because sizable imbalances on important site characteristics might emerge from a simple randomization, we implemented a 3-stage constrained randomization approach to limit imbalance between intervention and usual care control conditions on 5 site characteristics: capacity; % of minority clients; % of clients with dementia; urban, rural or suburban location; and private or public ownership. In stage 1, the Balance Match Weighted (BMW) re-randomization procedure was used to assign 30 sites to ADS Plus or control arms based on the best randomization out of 20 total randomizations for minimizing site imbalance. In stage 2, propensity scores from the BMW logistic regression analysis for reserve sites were used to determine substitutions for randomized sites that opted out of the CRT prior to implementation. In stage 3, a minimization approach was used to add 20 more sites to the trial. A standardized metric based on the half-normal distribution of the absolute value of mean differences was used to assess site imbalance. After stage 3, the remaining imbalance for the 49 enrolled sites was reduced by 75% from what would have been expected from a simple randomization. Optimized randomization procedures with similar imbalance metrics should be used more routinely in pragmatic CRTs.

‘I shall miss the company’: participants’ reflections on time-limited day centre programming

The social needs of frail or isolated older people are sometimes aided by referrals to day centres in the United Kingdom. Since the late 1940s, day centres have had a role to play promoting socialisation in later life. Additionally, attendance at day centres is often open ended, with participants only leaving due to moving to a nursing home or dying. In this study, the views of those attending time-limited day centre programmes in seven day centres in Northern Ireland have been sought in relation to their thoughts about the service as well as how they feel when it ends. Seventeen participants completed diaries for the programme duration and/or engaged in an interview process. Participants reflected on the social and educational benefits of attending but also recognised impositions in the centres that impinged upon individual choices and also the length of time they could remain. This study reveals that, in order to maintain socialisation, time-limited programmes must have clear follow-on strategies for participants. Additionally, respondents’ experiences reflect that a paternalistic model of care delivery remains in place that, whilst restrictive, reveals that access to the service is more specialised and not universal. Nevertheless, should day centres wish to remain relevant, it is important that service users are fully consulted about their desires and choices within the setting.

Day centres for older people - attender characteristics, access routes and outcomes of regular attendance: findings of exploratory mixed methods case study research

BACKGROUND

Social prescribing is encouraged to promote well-being, reduce isolation and loneliness. Traditional, generalist day centres for older people could be suggested by social prescribing, but little is known about their clientele or their outcomes. As part of a larger study of the role, outcomes and commissioning of generalist English day centres for older people, the characteristics of attenders at 4 day centres, their reasons for attendance and outcomes were explored.

METHODS

This mixed-methods study used qualitative interviews and standardised tools within an embedded multiple-case study design. Semi-structured interviews with older day centre attenders (n = 23, 62% of eligible attenders) of 4 day centres in south-east England, recruited purposively to reflect organisational differences, were analysed.

RESULTS

Participants reported non-elective withdrawal from socialisation following health or mobility decline, or losses. Apart from living arrangements and marital status, attenders' profiles differed between centres. Access had been mostly facilitated by others. Day centre attendance enhanced quality of life for this group of socially isolated people with mobility restrictions and at risk of declining independence and wellbeing. The positive impact on attenders' social participation and involvement and on meaningful occupation was significant (p-value < 0.001, 99% CI), with an average ASCOT gain score of 0.18. Ten outcome themes were identified.

CONCLUSION

Outcomes of day centre attendance are those targeted by social care and health policy. Centres were communities that 'enabled' and offset loss or isolation, thus supporting ageing in place through wellbeing and contributed something unique to their attenders' lives. By monitoring attenders' health and wellbeing and providing practical support, information and facilitating access to other services, centres offered added value. Attendance needs to be set in the context of other social engagement and care provision which may not overlap or duplicate centre support. Professionals may wish to explore the benefits of social prescriptions to day centres but should map local centres' provision, engage with their organisers, and seek information on attenders, who may differ from those in this study.

Physical activity benefits of attending a senior center depend largely on age and gender: a study using GPS and accelerometry data

BACKGROUND

Senior centers offer important opportunities for physical activity and social interaction. Seniors who visit a senior center regularly can gain physical activity from transportation and from specific activities offered within the senior center. However, there is very little knowledge regarding the specific physical activity gains obtained from regular visits to senior centers, and no effort has been made to use device-based measures of physical activity to test the potential physical activity benefits of attending a senior center.

METHODS

To fill this gap, the present study examined the physical activity patterns of 227 seniors living in the Barcelona Metropolitan Area in Spain. Using GPS and Accelerometer 7-day tracking data, and GIS measures we assessed the light physical activity and moderate-to-vigorous intensity physical activity (MVPA) benefits of attending the senior center on a weekly and daily basis.

RESULTS

Seniors who attended a senior center at least once a week did not accumulate significantly more daily physical activity (211.6 min; 95% CI 196.6; 226.6) than seniors without any visit 215.9 min; 95% CI 202.7; 229). However, on a day-to-day basis, it was found that visiting a senior center had positive effects in physical activity and was associated with less sedentary time among younger participants in general (- 18.2 daily min 95% CI - 33.2;-3.3 p = 0.016) and among older female participants in particular (- 19.7 daily min 95% CI -21.06;-18.5 p = 0.011).

CONCLUSIONS

The benefits of attending senior centers in terms of physical activity should not be viewed as universal, but rather as contingent to the demographics of the user, and the type of activity that the visit is replacing.

A Logic Model for Evaluation and Planning in an Adult Day Care for Disabled Japanese Old People

Adult day care (ADC) provides various services for meeting clients' needs. Based on the mini-Delphi method with 46 ADC staff and the discussions with eight ADC administrators, this study developed and finalized a comprehensive logic model to represent the elements of ADC. For the three basic structures of a logic model-inputs/activities, outputs, and outcomes-the model contained seven core categories and 23 sub-categories. The ADC inputs/activities consisted of two core categories: "Place to stay" and "Intervention from staff". These inputs/activities caused two kinds of outputs: "Clients' experiences" and "Families' experiences". "Accumulating experiences" with repeated ADC visits was established as the link between the ADC outputs and outcomes, which were "Clients' change" and "Families' change". ADC centers provide various experiences for their clients and their caregivers, ranging from the fulfillment of needs for fundamental care to psychiatric care and self-actualization. Improving various model-related inputs/interventions can produce better experiences and outcomes. The model can guide ADC administrators, policymakers, and researchers in the evaluation of a heterogeneous ADC service program that is community-based, thereby ensuring optimal care for clients with an efficient use of resources.

Exploring the Organizational Culture in Adult Day Services (ADS) and Its Effect on Healthcare Delivery in Taiwan

Studies conducted in nursing homes/hospitals have shown that organizational culture plays an important role in care delivery and group culture leads to better quality of care. To explore the organizational culture and care delivery in adult day services (ADS) centers in Taiwan, we used both quantitative and qualitative research methods. Quantitative data from the Competing Values Framework (CVF) assessment showed that the group culture was dominant at all three centers. Qualitative data from observation and staff interviews uncovered both group and nongroup cultural elements. The group cultural elements, such as flexible management, teamwork environment, and sharing the same values, contributed to good care; however, the nongroup cultural elements, such as the staff-centered view, hierarchy, and conflicts within the leadership, led to negative staff-staff and staff-clients interactions. Further research is needed to untangle the complexity between quality care delivery and organizational culture.

Day centres for older people: a systematically conducted scoping review of literature about their benefits, purposes and how they are perceived

With a policy shift towards personalisation of adult social care in England, much attention has focused on individualised support for older people with care needs. This article reports the findings of a scoping review of United Kingdom (UK) and non-UK literature, published in English from 2005-2017, about day centres for older people without dementia and highlights the gaps in evidence. This review, undertaken to inform new empirical research, covered the perceptions, benefits and purposes of day centres. Searches, undertaken in October/November 2014 and updated in August 2017, of electronic databases, libraries, websites, research repositories and journals, identified seventy-seven relevant papers, mostly non-UK. Day centres were found to play a variety of roles for individuals and in care systems. The largest body of evidence concerned social and preventive outcomes. Centre attendance and participation in interventions within them impacted positively on older people's mental health, social contacts, physical function and quality of life. Evidence about outcomes is mainly non-UK. Day centres for older people without dementia are under-researched generally, particularly in the UK. In addition to not being studied as whole services, there are considerable evidence gaps about how day centres are perceived, their outcomes, what they offer, to whom and their wider stakeholders, including family carers, volunteers, staff and professionals who are funding, recommending or referring older people to them.

Benefits of Multiple Sclerosis Adult Day Program Participation for People with Multiple Sclerosis: A Qualitative Study

Background

Multiple sclerosis adult day programs (MSADPs) are nonmedical service programs that provide care and support to people with multiple sclerosis (MS) experiencing levels of impairment that interfere with employment and activities of daily living. The purpose of this study was to identify how program participants think MSADPs benefit them.

Methods

We conducted in-depth interviews with 95 people with MS who were MSADP participants. Interviews occurred as part of site visits to ten programs across the country. We supplemented participant interviews with interviews of program staff and ethnographic observation of activities at each site over 1 to 3 days.

Results

Participants reported several benefits from participating in an MSADP. Almost universally, participants explained that receiving and giving social support were the most important benefits. Other positive outcomes described included increased emotional well-being, better understanding and acceptance of MS, practical know-how for accomplishing ordinary tasks, and increased mobility and improved motor functioning.

Conclusions

Participants believe that MSADPs have a profound influence on their psychosocial health, much of which they attribute to membership in a socially cohesive community. Clinicians and policy makers should consider recommending these programs for people with MS who have unmet psychosocial needs and experience functional impairments.

‘I want to make myself useful’: the value of nature-based adult day services in urban areas for people with dementia and their family carers

Nature-based adult day services (ADSs) in urban areas are relatively new services in the Netherlands. Since knowledge about these services is still scarce, this study aimed to elucidate their value for people with dementia and their family carers in terms of health and wellbeing. We interviewed 39 people with dementia attending nature-based ADSs in urban areas and their family carers, and 17 providers of these services. Respondents indicated that nature-based ADSs in urban areas positively affected the health and wellbeing of people with dementia. According to them, these services support contact with nature and animals, activity engagement, physical activity, structure, social interactions, healthy eating, a sense of meaning in life and a focus on normal daily life. Respondents further indicated that these services stimulate respite, reassurance and maintenance of family carers’ own activities and social contacts. We conclude that nature-based ADSs in urban areas have a wide range of benefits that might affect the health and wellbeing of people with dementia and their family carers. Worldwide, demand is growing for innovative practices in dementia care. It is therefore worthwhile monitoring the development of dementia care innovations, such as nature-based ADSs, and for countries to exchange lessons learned from these services.

Embedding caregiver support in community-based services for older adults: A multi-site randomized trial to test the Adult Day Service Plus Program (ADS Plus)

There are over five million people in the United States living with dementia. Most live at home and are cared for by family. These family caregivers often assume care responsibilities without education about the disease, skills training, or support, and in turn become at risk for depression, burden, and adverse health outcomes when compared to non-dementia caregivers. Despite over 200 caregiver interventions with proven benefits, many caregivers lack access to these programs. One approach to enhance access is to embed evidence-based caregiver support programs in existing community-based services for people with dementia such as adult day services (ADS). Here we describe the protocol for an embedded pragmatic trial designed to augment standard ADS known as ADS Plus. ADS Plus provides family caregivers with support via education, referrals, and problem-solving techniques over 12 months, and is delivered on-site by existing ADS staff. Embedding a program in ADS requires an understanding of outcomes and implementation processes in that specific context. Thus, we deploy a hybrid design involving a cluster randomized two-group trial to evaluate treatment effects on caregiver wellbeing, ADS utilization, as well as nursing home placement. We describe implementation practices in 30 to 50 geographically and racially/ethnically diverse participating sites. Clinical trial registration #: NCT02927821.

The role of day care in supporting older people living with long-term conditions

PURPOSE OF REVIEW

For older people with long-term conditions, regular structured activities within a community setting meeting others are thought to improve well being and quality of life. Historically local authority-run day care centres were widely available, but austerity measures have meant that in many areas, such provision has been markedly reduced and different models of day care services are being developed. There is little known about outcomes of day care provision for older people with long-term conditions.

RECENT FINDINGS

This review has critically examined the recent evidence on outcomes of day care provision for older people with long-term conditions and will focus on three areas - physical functioning, intergenerational provision and measurement of outcomes. In terms of interventions to improve physical functioning for older people with long-term conditions attending day care, there are few studies and it is difficult to generalize but there appears to be a trend for positive impact on physical functioning when activities are incorporated into a day care programme. There is a paucity of research on intergenerational provision, however, the small number of studies suggest positive benefits. Studies measuring outcomes for older people with long-term conditions attending day care services are very limited in terms of outcome data with the exception of a Canadian study, which suggested that attendance at day care could reduce hospital attendance and admissions.

SUMMARY

This review reveals a lack of research of day care provision for older people with long-term conditions. There is a suggestion in the small number of articles included in this review that there can be benefits both in terms of global outcomes of attendance and in improved physical functioning; there is limited evidence of the value of intergenerational provision. Robust research with collection of meaningful outcomes is required to ensure that the increasing number of older people with long-term conditions are enabled to access high-quality day care provision.

In Their Voices: Client and Staff Perceptions of the Physical and Social Environments of Adult Day Services Centers in Taiwan

Studies have examined the impact of environments on long-term care residents' quality of life; however, environment gets little attention in adult day services (ADS). The current study gives voice to clients and staff by capturing their perceptions of the physical and social environments of their ADS centers. Data were collected from 23 interviews with staff and clients and 270 hours of participant observations at two ADS centers in Taiwan. The authors triangulated field notes with interview transcriptions and analyzed them with the Grounded Theory coding procedure method. Findings reveal clients' and staff members' perceptions of appropriate and inappropriate physical and social environmental features affecting quality of life at the center and reflecting Taiwanese culture. We address how perceived appropriate features can be sustained or replicated and how perceived inappropriate influences can be remedied. Results can be translated into action research by implementing supportive environments for both staff and clients at ADS centers.

The Role of Adult Day Services in Supporting the Occupational Participation of People with Dementia and Their Carers: An Integrative Review

The increasing numbers of people with dementia places considerable stress on health and aged care services and has resulted in the development of community adult day services. Aim: The aim of this integrative review is to determine the extent to which these services support the occupational participation of people with dementia, and how they impact their primary carers. Method: The mixed-methods appraisal tool (MMAT) was used to identify relevant studies in the period 2011–2016. Results: Nine databases were searched and yielded 16 articles with a variety of research designs for inclusion in the review. Conclusions: Findings indicate that adult day services use a range of approaches to support attendees and their carers. In spite of these efforts, there appears to be a lack of interest in utilizing these services while a person is in the early stages of dementia. This suggests that policies in aged care, such as aging-in-place, need to consider the pressure and stress they exert on carer’s quality of life. Another consideration is to better promote the benefits of participating in adult day services in the early stages of dementia for both the attendees and their carers, thereby delaying the tendency towards early institutionalization.

"Making the best of what we have": The lived experiences of community psychiatric nurses, day centre managers and social workers supporting clients with dementia attending a generic day care service

AIM AND OBJECTIVES

This study explored the experiences and perspectives of community psychiatric nurses, day centre managers and social workers about supporting clients living with and without dementia attending a generic day care service. The purpose of the study was to elucidate approaches that enable clients living with dementia to access and derive benefit from the service.

BACKGROUND

In the light of international ageing demographics and strategy towards social inclusion, it is anticipated that demand for generic day care services for clients living with and without dementia will increase.

DESIGN AND METHODS

A descriptive qualitative design utilised three focus groups for data collection. Community psychiatric nurses (n = 4), day centre mangers (n = 4) and social workers (n = 12) participated in the study. Data analysis informed a narrative description of the approaches that support adults living with dementia in day care.

FINDINGS

An exhaustive description is encapsulated in five key themes. These are "easing the transition to day care," "proactively managing supervision and complexity of need," "sustaining the person and family carer," making the best of what we have" and "encountering a need for change," The data conveyed a sensitivity to the life story and needs of clients with dementia. Whilst the data revealed deficits in the physical environment of the centres, there were indications of the generation of a positive social environment.

CONCLUSIONS

A generic day care service that provides an integrated blend of care and treatment and social and recreational support to older adults, irrespective of whether they have or have not dementia, is realistic and manageable. The routine of day centre attendance may have value in sustaining clients with dementia and family care-giving relationships.

IMPLICATIONS FOR PRACTICE

Approaches to support the attendance of clients with dementia at day care include home visits, life story work, proactive supervision and careful planning of social groupings and recreational activities.

Community-based dementia day programmes: Common elements and outcome measures

Dementia Day programmes are considered important in supporting the well-being of both people living with dementia and their caregivers. There is, however, limited evidence on the effectiveness of these programmes. This article reports on a study undertaken in New Zealand on the effectiveness of community-based dementia day programmes. The small-scale pilot study was aimed at investigating the elements that make up an effective client-focused dementia day programme and the methods employed by organisations to measure the outcomes of these programmes. A mixed methods approach was employed with multiple stakeholders. The research revealed that effective day programmes comprised five core elements, and that surveys, reporting and auditing processes are routinely used to measure the quality of outcomes of day programmes. Although these findings are reflective of a specific context, it raises concerns about the nature and availability of evidence informing decisions regarding the design and implementation of day programmes internationally.

Green Care Farms: An Innovative Type of Adult Day Service to Stimulate Social Participation of People With Dementia

Objective: To explore the value of day services at green care farms (GCFs) in terms of social participation for people with dementia. Method: Semi-structured interviews were conducted with people with dementia who attended day services at a GCF (GCF group, n = 21), were on a waiting list (WL) for day services at a GCF (WL group, n = 12), or attended day services in a regular day care facility (RDCF group, n = 17) and with their family caregivers. Results: People with dementia in the GCF and WL group were primarily males, with an average age of 71 and 76 years, respectively, who almost all had a spousal caregiver. People with dementia in the RDCF group were mostly females with an average age of 85 years, most of whom had a non-spousal caregiver. For both the GCF and RDCF groups, it was indicated that day services made people with dementia feel part of society. The most important domains of social participation addressed by RDCFs were social interactions and recreational activities. GCFs additionally addressed the domains “paid employment” and “volunteer work.” Conclusion: GCFs are valuable in terms of social participation for a particular group of people with dementia. Matching characteristics of adult day services (ADS) centers to the preferences and capacities of people with dementia is of importance. Diversity in ADS centers is therefore desirable.

The effectiveness of adult day services for older adults: a review of the literature from 2000 to 2011

Adult Day Service (ADS) centers offer a variety of services to meet the needs of older adults and their caregivers. During the last decade, ADS has received increased attention due to shifts in policy toward home and community-based services for an aging population. This article reviews the effectiveness of ADS from 2000 to the present, with particular attention given to caregiver and participant outcomes, health care utilization, and future directions in ADS research. Multiple databases were searched to identify relevant research and 61 articles were selected for review based on inclusion criteria. The results of this review emphasize the need to implement and test more specific interventions targeting the needs of the ADS population.